Montreal – Uncertainty about the meanings of specific terms in the Canadian medical assistance in dying (MAiD) legislation must be addressed, says a new report from the Institute for Research on Public Policy.

The federal government passed legislation in June 2016 that allows eligible Canadians to request medical assistance in dying. But that legislation contains many terms that must be better defined, say the authors Jocelyn Downie (Dalhousie University) and Jennifer A. Chandler (University of Ottawa).

Interpretive uncertainty concerning Bill C-14 puts Canadians at risk in a number of ways, they say. “Individuals who should have access may be denied, while others may be given access who should not. This uncertainty may also result in a chilling effect on medical and nurse practitioners’ willingness to provide MAiD.” Additionally, serious problems arise in relation to the 10-day waiting period, where some patients may avoid ethically and medically appropriate pain control in order to maintain decision-making capacity.

Downie and Chandler identify the most problematic phrases in Bill C-14, which urgently need clarification, such as “intolerable suffering” or “an advanced state of irreversible decline.” They also address the most unclear and controversial phrase of all – “natural death has become reasonably foreseeable.” Does it mean that eligibility is limited to fatal conditions? Do patients have to be “terminally ill” or “at the end of life”? Does death have to be in the “not too distant future”? If so, how distant is too distant?

Downie and Chandler conclude by inviting all responsible authorities to adopt, endorse and/or disseminate the proposed interpretations in the report in an effort to provide much needed guidance to patients and health care practitioners and help build public consensus on these important matters. Among others, the authors suggest the Minister of Justice and Attorney General of Canada publicly state that the proposed interpretations are (or are not) consistent with the intentions of the legislation.

The Institute for Research on Public Policy is an independent, national, bilingual, not-for-profit organization based in Montreal. To receive updates from the IRPP, please subscribe to our e-mail list.